- +1 (773) 985-1869
- info@stream-rcm.com
- 14430 Ocean Point, El Paso, TX 79938
Nephrology billing involves frequent dialysis coding, chronic kidney disease (CKD) staging, and intricate ESRD monthly capitations. Stream RCM’s is providing nephrology billing services which involve experienced certified coders as well as claims scrubbing oriented toward nephrology with the aim of decreasing denials at the very outset. Our services will account for each CKD staging and dialysis modifier.
We have a dedicated team of certified nephrologists and reimbursement experts. Our team has a complete understanding of the intricacies associated with ESRD Prospective Payment System and Dialysis Bundling. We are also familiar with the latest chronic kidney disease staging criteria. Our team stays current with CKD staging guidelines, including the 2025 updates. This includes changes such as wage index adjustments, discontinuation of rural adjustment, and new oral drug bundling for phosphate binders. We work together to make sure that all the services are properly documented and billed. The services can range from hemodialysis to transplant follow up. We keep track of the local coverage determination (LCD) from the Medicare Administrative Contractors (MACs), which include Noridian and Novitas, to make sure you meet your region-specific documentation requirements. We not only have payer-specific knowledge but also have a denial management system which targets the problem of claim denials.
We will take care of your billing for both the in-center and home dialysis programs, guaranteeing that your capitation amounts, treatment counts, and modifiers are accurate for each month.
Our team code every CKD stage change properly to confirm proper E/M visits, laboratory panels, and staging for accurate reimbursement of your ongoing CKD monitoring services.
Our staff will bill pre-transplant evaluation, post-transplant care, and immunosuppression management services separately from regular nephrology services.
We bill hypertension-related renal visits along with CKD documentation, verifying accurate capture of the complexity of comorbidity for appropriate reimbursement.
Our team bills for fistula placement, graft procedures, and catheter management separately from dialysis services to avoid coding issues and potential loss of income.
Nephrology billing is continuously evolving. We make billing easier through efficiency that results in fewer errors, less delay, and more revenue for your practice.
We appeal complex nephrology denials with payer-specific strategies. Our team overturns 78% of ESRD-related denials, addressing issues like medical necessity and modifier errors.
Our specialists pursue aging dialysis and CKD claims persistently. We reduced days in A/R from 185 to 63 for a Texas nephrology practice in just 70 days.
Proactive internal audits identify missed charges and coding gaps. We recover 12-18% of potential lost revenue through comprehensive documentation reviews.
Certified coders with nephrology expertise. We certify accurate CPT/ICD-10 mapping for dialysis, CKD, and E/M services, reducing coding errors that lead to denials.
We manage payer enrollment and re-credentialing for your nephrologists, reducing onboarding delays by 60% and ensuring timely reimbursement.
We do payment posting with variance analysis. Our team posts every payment and adjustment precisely, reconciling remittances for full financial transparency.
Experienced nephrology billing specialists are hard to recruit and retain. Stream RCM is ready to streamline your revenue cycle, reduce denials, and boost your reimbursements from day one.
The dialysis capitation billing cycle, CKD documentations, and increasing administrative pressures create challenges for in-house billing. We decrease costs, scale up efficiently, and have access to high-quality billing experts without employing people.
Save 30-40% on operational costs compared to in-house billing teams. We manage your billing operations and allow you to focus on delivering exceptional patient care.
As your nephrology practice grows, we scale with you handling increased claim volume without any delay. We've helped practices expand from 2 to 15 providers seamlessly.
Our team stays updated on Medicare ESRD PPS changes, commercial payer policies, and state-specific guidelines. We track CMS updates like the 2025 wage index and outlier changes.
| Category | Codes Applied | How Stream RCM Uses Them |
|---|---|---|
| Dialysis Services | CPT 90935, ICD-10 N18.6 | We make sure that dialysis procedure codes are matched with proper ESRD diagnosis codes in order to have compliant capitation billing. |
| CKD Staging | CPT 99214, ICD-10 N18.3 | Our team verifies evaluation and management services are coded according to proper CKD stages coding in order to optimize payments. |
| Renal Biopsy | CPT 50200, ICD-10 N05.9 | Renal biopsy procedures are coded with appropriate nephrology diagnoses to improve claim accuracy and reduce denials by our certified coders. |
| Vascular Access | CPT 36901, ICD-10 Z99.2 | We coded vascular access procedures separately from dialysis services in order to be properly reimbursed without any billing overlap. |
| Transplant Care | CPT 50360, ICD-10 Z94.0 | Kidney transplant procedures and their follow-up care are documented with proper codes for the purpose of accurate reimbursement. |
One common issue in nephrology coding is incomplete CKD staging documentation in clinical notes. This can force coders to use unspecified diagnosis codes that may result in lower reimbursement and audit concerns. Clinical providers focus on patient care, so documentation gaps between care delivery and billing records can occur. Stream RCM works closely with providers to identify and resolve these documentation gaps. We provide feedback and templates to capture CKD staging, comorbidities, and treatment details accurately. Our approach reduces unspecified coding and strengthens audit protection for every claim submitted.
Our team works with your existing EHR/EMR systems without any disruptions or replacements. We integrate directly into your current clinical workflows.
CMS’s focus on home dialysis, including peritoneal dialysis and home hemodialysis, is changing nephrology care delivery. More patients are shifting from traditional in-center dialysis to home-based treatment options. This transition aims to increase patient control and reduce facility-based healthcare costs. For nephrology practices, it requires changes in billing workflows and practice management strategies. Home dialysis involves more capitation visits, remote check-ins, and coordination with training staff. Practices must adapt their coding processes to accurately capture home dialysis services and avoid missed revenue opportunities.
We identify and resolve the top revenue losses challenges in kidney care billing with proven strategies.
Our experience includes nephrology billing services that enhance the revenue stream for you to reduce errors and make the billing process simple.
Faster processing of claims and reduced denials result in increased revenues.
Certified medical coders and billers take care of all your nephrology billing services.
All regulations are ensured by regular audits and updating the coding process.
Detailed reports on claims, revenue, and denials enable making financial decisions easier.
We track dialysis modality changes, updates documentation, and adjusts coding promptly to prevent missed revenue and billing inaccuracies.
CPT 90960 is for ESRD monthly care with 4 or more face-to-face visits per month, while 90961 is for 1–3 visits. Our coding team ensures you select the correct code based on visit frequency to avoid underbilling.
We track all CMS updates and adjust our billing rules accordingly. We also analyze how payer-specific policies align with PPS changes to ensure your dialysis claims are accurately reimbursed.
Yes, we provide full MIPS data collection and submission services, including quality measure tracking and improvement activities, to help you achieve maximum incentive payments.
Connect with our nephrology billing specialists and receive your complimentary revenue cycle assessment today.
